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Carotid access in Transcatheter Aortic Valve Implantation – an alternative to the gold standard. A single-center experience

100%
Stańska A., Wierzbowska A., Targoński R., Karolak W., Mickiewicz A., Jaguszewski M., Jagielak D.
|
2019
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vol. 2
|
issue 2
80-84
EN
Background: Transfemoral access is regarded as the TAVI gold standard for the transcatheter aortic valve implantation (TAVI) procedure. However, other options for vascular access have developed in the last few years. Access via the carotid artery is one such alternative. Materials and methods: The study included 9 elderly patients who underwent transcarotid TAVI procedure at the Cardiac and Vascular Surgery Department of the Medical University of Gdańsk. Procedures were performed by a local Heart Team in a hybrid operating room under general anesthesia. Data was collected before the implantation and at discharge. Results: The mean patients’ age was 81 years of age (64-88) and the mean logistic EuroSCORE was 10.8 (7-16). Implantations were performed with 100% device success rate. Intra-operative valve-in-valve procedure was performed in one patient; there were no access-related and valve-related complications during the surgery. Post-procedural complications included minor bleeding, hematoma and pneumothorax. Echocardiographic parameters were significantly improving after the procedure. The mean hospital stay was 5 days (2-7 days). Conclusions: Transcatheter aortic valve implantation via the carotid artery appears to be safe and effective alternative to standard TAVI vascular access.
2
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Carotid access in Transcatheter Aortic Valve Implantation – an alternative to the gold standard. A single-center experience

100%
Stańska A., Wierzbowska A., Targoński R., Karolak W., Mickiewicz A., Jaguszewski M., Jagielak D.
European Journal of Translational and Clinical Medicine
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2020
|
vol. 2
|
issue 2
80-84
EN
Background: Transfemoral access is regarded as the TAVI gold standard for the transcatheter aortic valve implantation (TAVI) procedure. However, other options for vascular access have developed in the last few years. Access via the carotid artery is one such alternative. Materials and methods: The study included 9 elderly patients who underwent transcarotid TAVI procedure at the Cardiac and Vascular Surgery Department of the Medical University of Gdańsk. Procedures were performed by a local Heart Team in a hybrid operating room under general anesthesia. Data was collected before the implantation and at discharge. Results: The mean patients’ age was 81 years of age (64-88) and the mean logistic EuroSCORE was 10.8 (7-16). Implantations were performed with 100% device success rate. Intra-operative valve-in-valve procedure was performed in one patient; there were no access-related and valve-related complications during the surgery. Post-procedural complications included minor bleeding, hematoma and pneumothorax. Echocardiographic parameters were significantly improving after the procedure. The mean hospital stay was 5 days (2-7 days). Conclusions: Transcatheter aortic valve implantation via the carotid artery appears to be safe and effective alternative to standard TAVI vascular access.
3
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Clinical Evaluation of Near-Infrared Cerebral Oximetry in the Awake-Patient Carotid Endarterectomy

88%
Wojciechowski J., Sidorowicz M., Szyndler K., Znaniecki Ł., Trenkner M., Halena G., Brzeziński M., Rogowski J.
Polish Journal of Surgery
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2007
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vol. 79
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issue 8
519-525
EN
The aim of the study was to evaluate the usefulness of continuous monitoring of regional cerebral oxygen saturation (rSO2) for detection of brain ischemia during carotid endarterectomy.Material and methods. We performed 44 carotid endarterectomies using regional anesthesia, with simultaneous regional cerebral oxygen saturation monitoring in both hemispheres of the brain.Results. Oxygen saturation in the hemisphere ipsilateral to the operated carotid artery dropped from 65.1±8.1 to 58.2±10.7 after carotid artery cross-clamping. The difference was statistically significant (p<0.005). Oxygen saturation in the hemisphere contralateral to the operated artery did not demonstrate a difference between that before or after carotid artery closure (65.7±9.2 and 66.1±10.2, respectively, p=0.1). In five patients (11.4%) carotid artery clamping was associated with the appearance of neurological deficits. Shunt usage was necessary in four cases; the rSO2 decreased by 19.2±14% in this group. In the group without neurological deficit during carotid clamping, the rSO2 decreased by 9.7±10.3% (the difference between groups with and without neurological deficit was not statistically significant, p=0.5). In patients with a rSO2 drop above 20%, the sensitivity of the cerebral oximetry was 20% and specificity 97.5%, while the negative predictive value was 90.7%.Conclusions. Continuous cerebral oximetry is a simple and non-invasive method of patient monitoring during carotid endarterectomy. The rSO2 decreases significantly after the ICA clamping. The sensitivity of cerebral oximetry in prediction of neurological deficit during the procedure is low. Defining the threshold value of rSO2 decrease after ICA clamping as an indication for shunt was not possible with the results of this study.
4
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Intima–media complex thickness and carotid atherosclerotic plaque formation in Lublin’s population in the context of selected comorbidities

88%
Słomka T., Drelich-Zbroja A., Jarząbek M., Szczerbo-Trojanowska M.
Journal of Ultrasonography
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2018
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vol. 18
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issue 73
133-139
EN
Introduction: Atherosclerosis (arteriosclerosis) is a chronic arterial disease of the arteries with chronic inflammatory. The pathology of atherosclerosis is complex, and the atherosclerotic process is multi-factorial, not fully understood. Risk factors of atherosclerotic lesions may include: lipid disorders, hypertension or diabetes. One of the diagnostic methods of discovering atherosclerosis covers the assessment of the intima–media complex thickness by Doppler ultrasonography. Aim: The aim of this report was an evaluation of the relationships between intima–media complex thickness in the right and left carotid arteries and the occurrence of atheromatous plaque in the Lublin population with respect to three possible concomitant medical conditions, mentioned above. Material and methods: A group of 121 subjects was included into the study, all of the participants being residential inhabitants of the Lublin Voivodship. All the participating patients were requested to fill in a questionnaire. After that, the patients were submitted to Doppler sonography concentrated on intima–media complex thickness evaluation. The occurrence of atheromatous plaque was also assessed in obtained sonographic images. Results: There were statistically significant differences for the intima–media complex thickness and for the atheromatous plaque according to all of the reported diseases: hypocholesterolaemia, hypertension and diabetes. Conclusions: The present study confirms that there is a relationship between the thickness of the intima–media complex in the right and left carotid arteries as well as the occurrence of the atherosclerotic plaque regarding the coexistence of specific disease entities in the subjects of the Lublin population.
PL
Wstęp: Miażdżyca (arterioskleroza) to przewlekła choroba naczyń tętniczych o podłożu zwyrodnieniowo-zapalnym. Patologia miażdżycy jest złożona, a proces miażdżycowy ma charakter wieloczynnikowy, nie do końca poznany. W inicjowaniu zmian miażdżycowych biorą udział różne czynniki ryzyka, do których zalicza się m.in. zaburzenia gospodarki lipidowej, nadciśnienie tętnicze i cukrzycę. Jedną z metod diagnozowania miażdżycy jest ocena grubości kompleksu intima–media za pomocą ultrasonografii dopplerowskiej. Cel pracy: Celem pracy było zbadanie zależności pomiędzy grubością kompleksu intima–media w prawej i lewej tętnicy szyjnej oraz obecnością blaszki miażdżycowej a występowaniem jednej z trzech wymienionych wyżej jednostek chorobowych w populacji lubelskiej. Materiał i metody: Badaniem objęto losowo 121 osób z populacji lubelskiej. Badanych poproszono o wypełnienie ankiety. W kolejnym kroku badani byli kwalifikowani do ultrasonograficznej oceny grubości kompleksu intima–media. Oceniano także występowanie blaszki miażdżycowej w obrazie ultrasonograficznym. Wyniki: Stwierdzono istotne statystycznie różnice w grubości kompleksu intima–media z uwzględnieniem występowania wskazanych jednostek chorobowych: hipercholesterolemii, nadciśnienia tętniczego i cukrzycy. Stwierdzono również istnienie zależności pomiędzy obecnością blaszki miażdżycowej a występowaniem wskazanych jednostek chorobowych u badanych. Wnioski: Przeprowadzone badania potwierdziły, że istnieją zależności pomiędzy grubością kompleksu intima–media w prawej i lewej tętnicy szyjnej oraz obecnością blaszki miażdżycowej a współwystępowaniem opisywanych jednostek chorobowych u badanych w populacji lubelskiej.
5
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A relationship between serological markers of chronic C. pneumoniae and CMV infection and hsp60 in patients with atherosclerotic carotid stenosis

75%
Rabczyński M., Fiodorenko-Dumas Ż., Mastej K., Dumas I., Adamiec R., Paprocka-Borowicz M.
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2015
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vol. 62
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issue 1
89-95
EN
A number of epidemiological studies conducted over the last decade indicate a relationship between specific pathogen infections and the development of atherosclerosis, although no pathogenetic pathways connecting these two have been determined. Recent reports support the role of heat shock proteins (HSPs) in atherogenesis. The HSPs are also believed to be a link between the infection and the development of atherosclerotic lesions. The aims of study: Immunohistochemical evaluation of carotid artery segments to show the relationship between the presence of heat shock proteins and the serum levels of anti-hsp60 antibodies. An attempt to demonstrate a relationship between an expression of chronic C. pneumoniae and CMV antigens. Material and Methods: The study included 41 patients qualified for carotid artery endarterectomy and 18 healthy volunteers of corresponding age. Levels of anti- hsp60, anti-C. pneumoniae IgA and IgG, anti-CMV IgG antibodies as well as hsCRP were determined. Results: The mean serum levels of anti-hsp60 antibodies were higher in patients with advanced atherosclerosis as compared to healthy volunteers (55.3±64.1 vs 32.8±29.8; p < 0.05). There was a strong correlation between anti-hsp60 antibodies and the expression of hsp60 in carotid arterial wall, as confirmed by immunohistochemical evaluation. The study group showed statistically significant higher levels of hsCRP. Furthermore, statistically significant higher serum levels of anti-C. pneumoniae IgG and IgA as well as anti-CMV IgG antibodies were found in the study group as compared to controls. No correlation was shown between the markers of chronic infection induced by the tested pathogens and serum levels of anti-HSP and hsCRP. Conclusions: Higher protein expression in vascular walls is closely correlated with the level of anti-hsp60. At the same time, no significant relationship between anti-hsp60 antibodies and serological markers of infection was observed, which may only indicate an indirect role of infection in the assessment of breaking the immunological tolerance against autologous HSPs.
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